Provider Demographics
NPI:1154459519
Name:WOJDACZ, ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:WOJDACZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4483 OAKHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1959
Mailing Address - Country:US
Mailing Address - Phone:440-282-3358
Mailing Address - Fax:
Practice Address - Street 1:4483 OAKHILL BLVD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1959
Practice Address - Country:US
Practice Address - Phone:440-282-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN135183367500000X
FLARNP 9172911367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305565500Medicaid
FLG3188OtherBCBS
FLG3188ZMedicare PIN